Elevated Poster Presentation International Celiac Disease Symposium 2026

Toward scalable screening for celiac disease: point-of-care testing outperforms symptom-based case finding in primary care (139311)

Aurelio Seidita 1 2 , Pasquale Mansueto 1 , Salvatore Sorce 3 4 , Donato Cascio 3 , Giovanni Pratelli 1 , Anna Saitta 1 , Mirco Pistone 1 2 , Lucio Marsala 1 2 , Antonella Spitaleri 1 2 , Sonia Giardina 1 2 , Oriana Taibi 1 2 , Davide Martorana 1 2 , Simona Greco 1 2 , Carola Buscemi 1 2 , Federica Latteri 5 , Giovanni Tinervia 1 2 , Emanuele Amodio 1 , Giuseppe Raso 3 , Antonio Carroccio 1 2 , Carlo Catassi 6
  1. University of Palermo, Palermo, ITALY, Italy
  2. Department of Internal Medicine, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, Palermo, Italy
  3. Department of Physics and Chemistry - "E. Segrè", University of Palermo, Palermo, Italy
  4. Faculty of Engineering and Architecture, University of Enna "Kore", Enna, Italy
  5. Gastroenterology Unit, "V. Cervello" Hospital, Ospedali Riuniti "Villa Sofia-Cervello", Palermo, Italy
  6. Department of Pediatrics, Polytechnic University of Marche, Ancona, Italy

Introduction
Celiac disease (CeD) affects up to 1.4% of the population but remains largely underdiagnosed (1), particularly in Southern Europe (2,3), with substantial diagnostic delay and healthcare burden (4,5). Symptom-based case finding performs poorly in adults due to the high prevalence of non-classical presentations (6-9). Simple, scalable screening strategies for primary care are urgently needed. The ITAMA_CAP study evaluated a real-world screening approach integrating a point-of-care test (PoCT) and a symptom-based case finding questionnaire in an unselected adult population.

Aims and Methods
We aimed to uncover undiagnosed CeD cases in the general adult population and to compare the diagnostic performance of PoCT versus a case finding questionnaire. In this prospective multicenter study, 160 Sicilian general practitioners consecutively screened adults (≥18 years) using capillary PoCT for qualitative detection of anti-tTG2 antibodies and a standardized case finding questionnaire. At-risk individuals (PoCT positive or ≥5 positive responses) underwent confirmatory serology (anti-tTG2 antibodies) and biopsy when indicated. Diagnostic accuracy metrics were estimated accounting for verification bias and compared using the Youden Index.

Results
A total of 6573 subjects were screened; 27.8% were referred for further testing. Thirty new CeD cases were identified (prevalence 0.45%), likely underestimated due to high dropout rates. PoCT positivity strongly predicted CeD (39.7% vs 0.96% in questionnaire-positive/PoCT-negative subjects; p<0.0001). Standalone PoCT showed excellent specificity (99.0%) and very high NPV (99.8%), with moderate sensitivity (81.1%). The questionnaire showed limited diagnostic value. Although the combined approach increased sensitivity (95.4%), this reduced specificity (~72%), lowering overall performance. PoCT was the strongest independent predictor of CeD (OR 100.39, p<0.001).

Conclusion
In primary care, PoCT outperforms symptom-based case finding for CeD screening in adults. Adding a questionnaire provides minimal benefit and reduces specificity. A PoCT-first strategy may improve detection, reduce unnecessary investigations, and address the hidden burden of CeD.

  1. 1. Catassi, C.; Verdu, E.F.; Bai, J.C.; Lionetti, E. Coeliac Disease. The Lancet 2022, 399, 2413–2426, doi:10.1016/S0140-6736(22)00794-2.
  2. 2. Mansueto, P.; Spagnuolo, G.; Calderone, S.; D’Agate, C.C.; Cosenza, S.; Leonardi, G.; Camilleri, S.; Pistone, M.; Seminara, G.; Alaimo, C.; et al. Improving the Diagnostic Approach to Celiac Disease: Experience from a Regional Network. Digestive and Liver Disease 2022, 54, 771–775, doi:10.1016/j.dld.2021.11.016.
  3. 3. Greco, L.; Timpone, L.; Abkari, A.; Abu-Zekry, M.; Attard, T.; Bouguerrà, F.; Cullufi, P.; Kansu, A.; Micetic-Turk, D.; Mišak, Z.; et al. Burden of Celiac Disease in the Mediterranean Area. World J. Gastroenterol. 2011, 17, 4971–4978, doi:10.3748/wjg.v17.i45.4971.
  4. 4. Lenti, M.V.; Aronico, N.; Bianchi, P.I.; D’Agate, C.C.; Neri, M.; Volta, U.; Mumolo, M.G.; Astegiano, M.; Calabrò, A.S.; Zingone, F.; et al. Diagnostic Delay in Adult Coeliac Disease: An Italian Multicentre Study. Digestive and Liver Disease 2023, 55, 743–750, doi:10.1016/j.dld.2022.11.021.
  5. 5. Fuchs, V.; Kurppa, K.; Huhtala, H.; Mäki, M.; Kekkonen, L.; Kaukinen, K. Delayed Celiac Disease Diagnosis Predisposes to Reduced Quality of Life and Incremental Use of Health Care Services and Medicines: A Prospective Nationwide Study. United European Gastroenterol. J. 2018, 6, 567–575, doi:10.1177/2050640617751253.
  6. 6. Leffler, D.A.; Green, P.H.R.; Fasano, A. Extraintestinal Manifestations of Coeliac Disease. Nat. Rev. Gastroenterol. Hepatol. 2015, 12, 561–571, doi:10.1038/nrgastro.2015.131.
  7. 7. Heijdra Suasnabar, J.; Meijer, C.R.; Smit, L.; van Overveld, F.; Thom, H.; Keeney, E.; Mearin, M.L.; van den Akker-van Marle, M.E. Long-Term Cost-Effectiveness of Case Finding and Mass Screening for Celiac Disease in Children. Gastroenterology 2024, 167, 1129–1140, doi:10.1053/j.gastro.2024.07.024.
  8. 8. Meijer-Boekel, C.; van den Akker, M.E.; van Bodegom, L.; Escher, J.; van Geloven, N.; van Overveld, F.; Rings, E.H.H.M.; Smit, L.; de Vries, M.C.; Mearin, M.L. Early Diagnosis of Coeliac Disease in the Preventive Youth Health Care Centres in the Netherlands: Study Protocol of a Case Finding Study (GLUTENSCREEN). BMJ Paediatr. Open 2021, 5, e001152, doi:10.1136/bmjpo-2021-001152.
  9. 9. Primavera, G.; Aiello, A.; Grosso, C.; Trifirò, G.; Costa, S.; Grima, A.; Pallio, S.; Toumi, M.; Magazzu’, G.; Pellegrino, S. Point‐of‐Care Test Screening versus Case Finding for Paediatric Coeliac Disease: A Pragmatic Study in Primary Care. Acta Paediatr. 2021, 110, 337–339, doi:10.1111/apa.15514.